Dr. Annie Coates (Guest): Absolutely. Well, thank you so much, Melanie, for having me and introducing me on to the show. That’s an excellent question that you asked. As you noted in the opening segment, asthma is a long-term lung disease that inflames and narrows the airways. There are many different things that can inflame and narrow the airways. Overall, the goal of care really is targeting and trying to understand what causes that inflammation and the various symptoms that patients can experience and how we can reduce them from occurring so that we can control the disease.
Melanie: Let’s start with once you’ve been diagnosed. What symptoms would be coming up that would send the parents to see a pulmonologist, to see if their child does have asthma?
Dr. Coates: That’s a great question. I’ll tell you that there are a number of different signs and symptoms that parents should absolutely be on the lookout. One of the first is coughing. There are many different things that cause cough. But usually, coughing from asthma is worse at night and early in the morning, and it can make sleep very difficult. Other types of symptoms to be aware of and be on the lookout for include wheezing. Wheezing is a whistling or a squeaky noise that occurs when you breathe. Usually, in asthma, it occurs when you breathe out as opposed to when you breathe in, but sometimes that can occur both times. Chest tightness is another symptom that patients can experience, and that’s when they feel like something is squeezing or actually sitting on the chest. And another common symptom is shortness of breath, and that’s when people feel like they can’t catch their breath or feel out of breath, almost like you can’t get enough air in and out of your lungs.
Melanie: Okay, so if they go see a pulmonologist, you diagnose this with asthma. What is the first step? What is the first line of defense that you work with both the child and the parent to deal with? Do you look for triggers? Do you start them on medications? Also, Dr. Coates, back in the day, children with asthma were told no exercise, stay out of gym, but that’s completely different now, too. Speak about that whole goal of treatment and your first line of defense.
Dr. Coates: Absolutely. Those are great questions. Well, first, it gets back to what causes the asthma. And so, when a child comes and either meets with myself or one of my colleagues—there are three other pediatric pulmonologists at Maine Medical Center and one of our nurse practitioners as well—we’ll be trying to understand what the different triggers and cause of the asthma is for that particular child. Most people who have asthma also have allergies. Allergies are a common trigger for asthma. We’ll really be trying to understand what contributes to that inflammation, that swelling, that narrowing of the airway and trying to minimize exposure. For example, cats are a very common allergy, and if cats are in the home of individuals who have asthma or a child is sleeping with a cat, that may be something that we would recommend having be removed from the home. Smoking and tobacco exposure, secondhand smoke, third-hand smoke, fourth-hand smoke, are also very common triggers. And so, those would be some of the questions that we will be trying to ask and understand if the child was exposed to certain types of triggers like that that would be worsening their asthma. In terms of how we treat asthma besides removing those triggers, there are multiple different medications that we use that all get back to trying to reduce that swelling, that inflammation, the mucus that can develop in the airways. There are medicines that you would breathe in, some on a daily basis, some just as needed, and there are also medicines that you can take by mouth that you can swallow that may be once a day. But it would really depend on first understanding what contributes to the asthma and then also trying to remove anything that could be potentially worsening it in the home, like smoke, like animals, like dust, for example. In regard to exercise, exercise is one of the best things that we all can do to keep ourselves healthy. It helps our heart, it helps our lungs, it helps mental health as well, and so it’s certainly something that we all at Maine Medical Center encourage our patients to participate in, and in some children who really just have exercise as a trigger for their asthma, that’s something that we work with them in trying to figure out the right combination to help them exercise as best as they can.
Melanie: Dr. Coates, when you’re working with parents and their children in adherence to all of these goals of treatments, this asthma action plan you’re talking about, with the long-term medications and even those rescue inhalers, how do you work with the kids to get them to be able to do it properly? Because isn’t that a big key for these things to even work?
Dr. Coates: Absolutely, it is. Absolutely. And I think it goes back to understanding what asthma is, what causes it, and how best to treat it. I think when we work with families and work with their children, education is the main component of that visit, that time together. Teaching the children and families what the different types of medications are, like you mentioned there, steroid inhaler or we call it a preventative inhaler as opposed to the rescue inhaler, one that they would just use as needed, when they’re starting to experience some of the symptoms that we talked about. The various providers at the Maine Medical Center pediatric pulmonary office, which includes my three other pediatric pulmonary colleagues, our nurse practitioner, and five different asthma educators in addition to the doctors and nurses who are there, really focus on how to use the different types of medications that we recommend, when you would use the different types of medications, and if there are any questions or concerns, how to contact us. There’s always somebody 24/7 who is available, specifically a physician, who can answer any questions or concerns. And one of the important pieces of information that we give our patients and families is something called an asthma action plan that we developed that has all the different medications on it that we recommend for your child’s asthma, how much medication they need to be taking, when they should be taking that medication, and if they’re starting to get sick, starting to show their symptoms that we talked about, like the coughing, like the wheezing, like the shortness of breath, how they would then increase their therapy to help get better control of those symptoms.
Melanie: Does asthma go away as you become an adult?
Dr. Coates: It’s a great question. And I’ll tell you that unfortunately, we don’t know the exact cause of asthma. And along those lines, we also know that asthma can occur at any time. A third of all children wheeze before the age of three, and only a third of those children go on to actually have asthma by the age of five to six. That majority of children who have symptoms of asthma really have them resolved by the age of six. But like I previously mentioned, an individual, particularly if they have a family history of it and other different types of environmental irritants, can develop asthma anytime in their life. The important thing is recognizing the symptoms, talking to your doctor about it, and starting therapy that your doctor recommends to really develop and help control the asthma.
Melanie: In just the last minute, if you would, Dr. Coates, give your best advice for those suffering with asthma or parents with children with asthma and why they should come to Maine Medical Center for their care.
Dr. Coates: That is a great question. I just feel that I want the families and patients to know that you are not alone. This is the most common long-term lung disease affecting children, adults in the world. Just in the United States, there are 25 million people who are afflicted with asthma. Seven million of them are children. Every day, we are working on how we can better control asthma and keep their symptoms at bay as best as possible. I think understanding what can cause it and how the disease can come about is an important thing that we try and work with our families and patients and doing as a team with both physicians, nurses, asthma educators who are both trained as nurses and respiratory therapists. We really try to provide the most caring, thoughtful, thorough, up-to-date care that we can for the children and families of Maine.
Melanie: Thank you so much, Dr. Annie Coates. You’re listening to MMC Radio. For more information, you can go to mainemedicalcenter.org. That’s mainemedicalcenter.org, mmc.org. This is Melanie Cole. Thanks so much for listening.